106-240 Criminal background and registry checks A.2. Define direct supervision. Does this mean the individual cannot be out of the sight of the supervisor? Registry checks take extended time to complete and this would complicate the onboarding. B.3Suggesting the regulations state the provider has a policy and that the regulations do not dictate an annual percentage. Performing this duty on 20% of employees on an annual basis creates administrative hardship- will prove to be a significant HR workload and agency financial hardship. Suggest the regulation states the provider has a policy and the regulation – don not dictated an annual percentage. The provision adds that person with funded complaints of abuse or neglect cannot be employed. There is no provision of a timeframe and allow providers to decide after understanding the details of the abuse or neglect. The new regulation 106-240 will be a problem. This is a recommended language change. – The Onboarding Redesign Task Force is proposing that FCG CSB offer letters do not include the start date, but state that the date will be determined after receipt of successful background checks. 106-250 Full-time and part time employee records A9. The requirement for drivers to have Virginia driver’s licenses is unreasonable. May providers have employees from surrounding states and additionally this is discrimination against military personnel and spouses who by law are allowed to keep a driver’s license from their “home” state. Undue barrier to employment to limit to Virginia driver license only. Specify if assessment for TB is sufficient. In recent years, there has been a shortage of serum needed to do TB testing, affecting ability to have all certified as TB free; rather assess and determine if warrant actual TB test. Redundant of 106-320. A.5. Three job-related references supporting the knowledge, skills, and abilities of the minimum qualifications according to the job description might not be attainable for young employees. This requirement will deter providers from hiring young employees who don’t have more than one or two previous jobs. This should be reduced to two, if a person has worked one place for a long time it may be difficult to get three. Two is reasonable. Also, should allow for a performance evaluation in lieu of a reference. We do not want to hinder hiring a person because they can’t come up with three references, we are already experiencing a shortage. 8. Not everyone uses the Department for background checks, those board that are part of County government use their county. Language needs adjusting to allow for that. 13. Define what competency testing is referred here? Add “as applicable to the position” – not all positions require separate competency testing. Adding this requirement is unneeded burden for some position. A 1-10 – The County DHR currently mandates recruitment and records policies and holds all the official personnel records, so CSB would have no control of changing what and how records are obtained and held. CSB HR complies with all DHR policies, regulations and procedural memoranda. This would require a change in the countywide HR policies. 106-260 Contracted Employees See comments in 106-250 that also apply. Employers are shifting to 3rd party vendors for primary source verification of education history. More reliable than transcripts. Add this as an option Allow for driver’s licenses from other states; these are valid across the U.S., Virginia boarders on several states and employees may reasonably live in them, heavy Military presence in Virginia and family members may maintain license from a different state. People may relocate. Undue barrier to employment to limit to VA TB results – not specified. Request same as above. OR 106-320 A 10. The questions to the legality of the ability to obtain these documents from contracted agencies. E.g. the contracted agency may not want to share specifics of the evaluation. The requirement as written increases the amount of documentation and training required which would prohibit services delivery. This makes the ability to retain contacted employees more difficult and reduces the ability to retain robust person-centered continuity of care. C. copy of all the contractor or temp agency items for personnel file is not feasible-due to human resource law, the CSB is not able to have copies of certain documents, and it means changing all the contracts in place and possibly doing double documentation/processes-a paperwork burden 106-300 Employee Training B.1 Does this training apply to Admin staff as well or only individuals working directly with the person served. It’s not possible to provide First Aid and CPR training within the first 7 days. Should not give a time frame but state that a person cannot work alone without becoming certified. CPR, First Aid, Medication Administration, and Behavior intervention such as TO/CPI are among more difficult trainings to obtain. Also, impact on employers when small number of employees are onboarding concurrently. If not able to move to within 30 days, recommend making this consistent with 14 business days. A.these states all areas mentioned should be demonstrated with competency testing. Several areas are mentioned in 106-300 are informational and do not need testing. Should specify those requiring testing. Example; objectives and philosophy of a provider is informational does not need to be a test. Requirements to complete the trainings within 7 business days after employee start date. This includes CPR, First Aid and medication administration. This is a huge burden and cannot likely be accommodated in most jurisdictions. CPR and First Aid are not offered on a daily or weekly basis with adequate opening to accommodate this. Staff would need to be scheduled to attend the training before their first day of employment, raising logistical and employee relations issues. Medication administration training is a multi-day training and is typically offered once a month, not twice a week which would be required if employees are to have completed the multi-day training before 7 days. Requiring these trainings within 7 days is not feasible. In addition, the staff with these trainings are not allowed to be in direct client care until their background check comes back, so requiring this ahead of time does not accomplish anything. Programs are required to have staff on site with First Aid and CPR so there is no need to identify that a new employee must have it within a given timeframe. Other staff are available on site should there be a need. Staff are not scheduled to administer medication until they have completed their training and are certified. There aren’t enough Medication Administration Training classes on various days to accommodate this across the state. In addition, this regulation seems to assume that staff are working during these 7 business days. However, relief staff or other part time staff may only work one day during their initial 7 day period. This must be accommodated. The goal of this regulation seems to be to ensure that staff are properly oriented and trained prior to being in the role of ensuring safety for clients. Requiring an unrealistic 7 day timeframe that does not take logistics of scheduling different classes with different vendors actually accomplished the opposite. In addition to these requirements, there are Federal. State, DMAS and county/CSB orientation requirements. With all the required “paperwork and training” Staff are worried about just checking off the paper such that they rush through important information. The new employee is overwhelmed and will not learn and remember under this situation. This actually creates a higher likelihood that the employee will not remember important information in an emergency situation. During the timeframe immediately after hire, employees are not responsible for client welfare as their background check is not back. Allow for real and appropriate training and orientation that the employee has a chance to assimilate. By following the wording below, the underlying goal of the regulation is accomplished. Recommend: Completing all the trainings needed within 7-14 days is challenging with the multiple regulatory agencies overseeing a large CSB as well as all the requirements from Federal/State/Local training, 15-30 days is more reasonable. Remove CPR, first Aid and Medication Administration from B1. Change B to say “New Employees contractors, volunteers and students shall be oriented and trained commensurate with their function or job specific schedule and duties as indicated in 1-3 below before being cleared to assume the responsibility of a Direct Care position or within 30 days, whichever comes first. In addition, the results of training are kept in the county’s Employee U system not in each employees CSB HR file. This would require changing in the countywide HR policies. B.4 States all new employees, contractors, students and volunteers must be supervised and demonstrate competency through testing . Add, as applicable. Same issue as above 106-310 Notification of policy changes B .Notification to OL of changes to policies prior to implementation places undue burden on both OL and providers. Slows the process of updating What is their turnaround time? What about need to respond to other changes quickly (e.g. laws). Recommend that review of policies be integrated more routinely into site visits by Licensing Specialists 106-320 Tuberculosis screening Specify if assessment for TB is sufficient. In recent years, there has been a shortage of serum needed to do TB testing, affecting ability to have all certified as TB free; rather assess and determine if warrant actual TB test. Adds that each new employee must have a TB test prior to initial contact with individuals. This is not feasible. Staff will be located in the same building as clients and will have contact. It is not logistically feasible to have the test before the staff reports to work. TB has not been a big issue and adding one more administrative burden just increases the time before a staff position can be utilized for client services. Recommend leaving as is-, within 30 days of employment 106- 330 Performance evaluation All performance evaluations are kept in the county’s Perform system, not in each employee’s CSB HR file. This requirement would be a huge problem for the CSB. 106-350 Disciplinary actions A. The documentation and appeals of disciplinary actions have rules around them and cannot be maintained after a certain amount of time per the legal department o the county (B)(1-4) Policies for employee and contractor that lists discipline and penalties for abuse, neglect, exploitation and violation of client rights or providers policies. This policy will wind up being relatively vague as our Human Resources Department has a “it depends” approach. Will most likely use language like “up to and including”. 106-380 Regular business hours If the provider posts their hours on their website this should be sufficient public notice for the department. Submitting regular business hours seems micromanaging. 106-400 Mission Statement If the provider posts their mission statement on their website and keeps it current is that sufficient notice to the Department? Does a change or update require a service modification form? How is the Department notified and to whom a licensing specialist? 106-430 Cessation of services B. Documentation that written notification of information such as intent to cease operations would be documented in a progress note, not a treatment plan. A treatment plan would be updated to note the date services are ended. 106-450 Emergency transfers Does this regulation apply residential transfers to Crisis Care ? 106-480 Policies 1 c: CSB’s that are part of local government will follow the guidance of their locality, which may not involve the purchase of a bond. The new language doesn’t allow for this flexibility. 18. A traffic pattern for center-based services that establishes a safe process for drop-off and pick-up of individuals who are transported by motor vehicle with site-specific application-: this needs more clarification of what you are expecting in a policy. 106-490 Emergency medical information A. Every provider has a different way of setting up their record. To prescribe where information should be placed in the medical record is too prescriptive. It should be available in the individual’s record, not regulating that it is on the face sheet. Additionally, a “face sheet” suggest paper copy which is obsolete- Electronic Health Record demographics /profile is used to keep the emergency medical information updated and current 106-510 Service description requirements A: Recommend original language of making the service descriptions available as opposed to publishing and posting. 106-520 Medication management Need to see the disability specific licensing regulations /chapters to comment appropriately 106-530 Behavior interventions and supports Need to see the disability specific licensing regulations /chapters to comment appropriately 106-570 Reporting to the department C. Request moving RCA to read 30 business days. Root Cause Analysis: Should be completed on some Level II and Level III’s and as part of an investigation, it is not appropriate, nor is it a good use of staff time to do them on every Level II and Level III incident. Put ER visit in lieu of a physician’s office visit back in the language-that is really clear and saves a lot of unnecessary paperwork for staff Filling out a SIR for first aid is a paperwork burden, it makes sense if the incident of first aid morphs into a medical issue, then a SIR is appropriate. 106-590 Monitoring and evaluating service quality C. 1-3 & D 1-2 Clarification is needed as to what types of complaints are associated with licensure regulations that are not human rights, is this not a Department requirement for providers? This is confusing. It reads like another process similarly to human rights. This is a new system structure added to providers with no funding for the staff to implement this new structure. What are the examples of how this would be implemented? Internally staff report on each other and it is investigated when a licensure regulation is not implemented? Clarification is requested. 106-630 Human rights it is necessary to have significantly more serious incident categories, as the several there are used as a “catch all” and labels are put on them that are severe-when in fact the SIR may not fit into the category and the reporting/data is skewed 106-700 Floor plan and building modifications Consider requesting clarification re renovations/examples (e.g. countertop replacement?) If there is no impact to individuals served is a service modification needed? Siding on the house is a service modification needed? 106-710 Traffic pattern All programs or just day programs? Would not be consistent with normative life to submit for a group home setting. 106-720 Lighting C.: This is for residential services, is a night light sufficient? 106-740 Personal necessities A. Is this when individuals are not able to afford it themselves that the program would pay for it C. 4. – child, other individual, or themselves? 106-810 Emergency preparedness and response plan D. If the CSB is part of a County government the communication occurs on an ongoing basis. The CSB would be part of their Counties EOC. What type of documentation of outreach is expected? 106-820 Access to telephone in emergencies; emergency telephone numbers A: clarification needed; is this is for all services? Yet, C states does not apply to home or non-center-based services and correctional facilities.